WHAT’S UP DOC? Night terrors can be scary for kids, parents

Tuesday

Dec 12, 2017 at 9:28 AMDec 13, 2017 at 6:13 PM

By Dr. Jeff Hersh/Daily News Correspondent

Q: We heard my 4-year-old daughter screaming about an hour and a half after she went to sleep. When we got to her room she was sitting up in bed just staring at the wall. She said she did not remember what scared her. Are nightmares common in kids?

A: There are five stages of sleep. Stage 1 is falling asleep, where your eyes fight to stay open and your body begins to relax. Stage 2 is the light, dreamless stage right after falling asleep. Stage 3 and 4 are deeper dreamless sleep, where the brain wave activity slows down. Finally, there is the rapid eye movement (REM) sleep stage when dreams occur.

Nightmares and sleep (night) terrors are examples of parasomnias, abnormal nervous system function during sleep. There are many other types of parasomnias, including bet wetting, confusional arousals, sleep walking, and others.

Nightmares occur during REM sleep and hence usually within hours of awakening. Symptoms include awakening (or being easy to awaken) from sleep feeling fearful, upset and afraid, sometimes screaming, often with fast heart rate and sweating. The child will be alert upon awakening, and will usually remember a lot about the nightmare and what scared them.

Nightmares are very common in kids (most common between ages 3 and 6), with over three-quarters of all kids having had at least one while growing up. They can be brought on by stress, anxiety, being over-tired, as well as fever and certain medications. There may be a genetic component to having frequent nightmares as this condition runs in families. However, less than half of kids have one a month (called nightmare disorder), and only about 5 percent have at least one per week.

The description in today’s question sounds more like a sleep terror (ST). ST’s occur during non-REM sleep, so usually between one and three hours after falling asleep. Symptoms include screaming/yelling as if afraid while asleep, sitting bolt upright and staring, not being easily awakened so not being able to be consoled, and being confused when finally becoming fully awake. Kids who have ST’s do not remember the episode, which typically lasts minutes (although it can last up to half an hour). It is not uncommon for there to be recurrent episodes.

Recurrent ST’s may affect 1 to 6 percent of kids. Triggers of this condition are similar to those of nightmares, and there is a genetic component (it runs in families). It is most common between ages 4 to 12.

The diagnosis of ST’s is made based on the history (there are typically no physical exam findings), including being unresponsive during the episode, having little or no recall of it, and the episode not being explained by another condition or a reaction to a medication. Rarely a sleep study (to rule out other conditions, such as sleep apnea, as well as to capture an episode to verify in what part of the sleep cycle it occurs) is indicated.

ST’s are almost always a self-limiting condition, typically resolving over weeks to months, although in some kids it can last much longer. The condition is completely resolved by adolescence in over 95 percent of cases.

As the child typically does not remember the episodes, it is sometimes even more frightening for the family than the child. Episodes are usually not very frequent, and minimizing possible triggers by ensuring a relaxing environment, minimizing stress and making sure the child is not over-tired, are key parts of the treatment. Counseling for the family (so they understand more about this condition) is important.

If episodes are frequent and concerning enough, it is sometimes beneficial to awaken the child prior to their episodes (often very effective, and when they are allowed to go back to sleep it is much less likely that an episode will occur). Keeping a sleep diary to be able to understand the timing of the ST is helpful in figuring out when to wake them. Very rarely medications are needed to help minimize episodes.

Sleep disturbances are very common in young children, but thankfully most resolve on their own over months to years, and almost always by adolescence. However, the symptoms can be concerning (to the family and to the patient), and interference with sleep can have negative ramifications in school and other activities. Speak with your pediatrician if your child is having a sleep disturbance, as identifying the issue and learning about it can minimize the worries of both the family and the child, as well as avoid possible complications.